Maharahstra: Make sure to notify any Tuberculosis (TB) cases that you come across. Not doing so may bring a penalty ranging from Rs 10,000- Rs 50,000 on private practitioners, states a recent report in TOI.

The harsh norms are coming in response to the meagre reporting by doctors that is taking place, in the light of the fact that TB is a notifiable disease. The state government of Maharashtra, desperate to control the rising menace of the disease is now drafting a bill that proposes to impose a fine to the tune of Rs 10,000 to Rs 50,000 on errant private practitioner who are failing to report the cases to the government.

“Maharashtra will be the first state in the country to have an independent law to effectively monitor reporting of TB cases to the government by private healthcare facilities,” said Sunil Khaparde, deputy director general (TB control), Union health ministry , told TOI .

State tuberculosis officer Sanjeev Kamble said, “The draft proposes to impose a fine of Rs 10,000 to Rs 50,000 on private medical practitioner, who has failed to report a case of TB under his or her care to the government. The draft is at the stage where it is undergoing final modifications and changes.”

It is reported that atleast half of the TB patients in the country are managed by the private practitioners and yet there is a serious lacuna in the notification of the disease, hence leading to the government struggling with surveillance and hence proper intervention mechanisms

Kamble further said, “The aim is to bring every case on government record. Understanding the exact disease burden of TB is paramount to devising strategies to contain the disease. We sent the draft for perusal and consideration to the state secretariat eight days ago. A final meeting of all the experts who have contributed to the drafting of the proposed bill will take place on October 20 in which some modifications and changes will be incorporated and the final draft will be resent to the state government for legislation only after consulting all the stakeholders,” Kamble said.

TB epidemic in India larger than previously estimated: WHO

Tuberculosis epidemic in India is “larger” than what was previously estimated, the World Health Organisation (WHO) on Friday said while asserting that the country was one of six nations which accounted for 60% of the new cases in 2015.

The Global Tuberculosis Report 2016 which was released today, however, said the number of TB deaths and incidences rate continue to fall globally as well as in India. “The TB epidemic is larger than previously estimated, reflecting new surveillance and survey data from India. However, the number of TB deaths and the TB incidence rate continue to fall globally and in India,” WHO said.

It said that in 2015, there were an estimated 10.4 million new (incident) TB cases worldwide, of which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children while people living with HIV accounted for 1.2 million (11%) of all new TB cases. “Six countries accounted for 60% of the new cases – India, Indonesia, China, Nigeria, Pakistan and South Africa.

“In 2015, there were an estimated 480000 new cases of multidrug-resistant TB (MDR-TB) and an additional 100000 people with rifampicin-resistant TB (RR-TB) who were also newly eligible for MDR-TB treatment.

“India, China and the Russian Federation accounted for 45% of the combined total of 580,000 cases. There were an estimated 1.4 million TB deaths in 2015, and an additional 0.4 million deaths resulting from TB disease among people living with HIV. Although the number of TB deaths fell by 22% between 2000 and 2015, TB remained one of the top 10 causes of death worldwide in 2015,” it said.

WHO said that in 2015, 6.1 million new TB cases were notified to national authorities and reported to WHO while notified TB cases increased from 2013 2015, mostly due to a 34% increase in notifications in India. “However, globally there was a 4. 3 million gap between incident and notified cases, with India, Indonesia and Nigeria accounting for almost half of this gap. The crisis of MDR-TB detection and treatment continues.

“In 2015, of the estimated 580000 people newly eligible for MDR-TB treatment, only 125000 (20%) were enrolled. Five countries accounted for more than 60% of the gap – India, China, the Russian Federation, Indonesia and Nigeria,” it said.

WHO said that the upward revisions to estimates of the burden of TB disease in India for the period 2000 2015 follow accumulating evidence that previous estimates were “too low”.

“This evidence includes household surveys, a state-wide TB prevalence survey, studies of anti-TB drug sales in the private sector, notification data and new analysis of mortality data. “Since India accounts for more than one quarter of the world’s TB cases and deaths, these revisions have had a major impact on global estimates. Estimates for India are considered interim, pending a national TB prevalence survey scheduled for 2017/2018,” WHO said.

Giving out details about India, WHO said mortality (HIV+TB only) was 37 per thousand while incidence (HIV+TB only) was 113 per thousand. Estimated TB incidence in India in 2015 in the age group of 0-14 years for both males and females was 255 per thousand.

Commenting on the report and the disease in the South East Asian Region which also includes India, WHO Regional Director (SEARO) Poonam Khetrapal Singh said TB remains a serious problem across the region and requires the fullest attention and strongest commitment of governments. “As outlined in WHO’s new global report on TB, a number of countries in the region are among the world’s highest TB burden countries, while revised estimates based on increased case-reporting and enhanced surveillance show that the TB caseload is higher than previously projected. TB is the single largest cause of death of any infectious disease in the region, and remains responsible for incalculable suffering, premature mortality, impoverishment and foregone development,” she said.

She said though countries have been making efforts to end TB and the number of TB deaths and its incidence rate continues to fall, at the current trend the region would not be able to achieve the SDG targets. “A newer and bolder approach is needed to bend the curve faster and sharper to achieve the global targets. This means intensifying measures to ensure early diagnosis and treatment, such as active case-finding and enhancing access to cutting-edge diagnostic tools. Adopting newer approaches of case diagnosis, community based treatment and treatment of latent infection. It means integrating TB programmes with existing health systems, thereby amplifying the effect these interventions have,” she said.

Singh also said that funds must be allocated accordingly, while political commitment must be fortified and both must occur at national and international levels.

There was once an article I had written on the story of the whipping boy who would be punished every time the prince did something wrong. Doctors of modern medicine are todays whipping boys for the governments misdeeds. Si the tuberculosis is rampant , deaths and drug resistance is increasing because of Government sponsored quackery. Whipping the qualified doctors for not reporting patients they treat is throwing dust into eyes of the public. The impression being created is that the cause of mismanaged TB in India is the MBBS doctors. This is dangerous move fraught with same risks as faced by ultrasonologists and form F. Administrative work and data collection and reporting takes up more time of Government doctors than the clinical work. Now private doctors will share this administrative load without ofcourse a pittance being paid to them. This will not restrict itself to TB only.
Dr Neeraj Nagpal
Convenor
Medicos Legal Action Group (MLAG)

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